C-Section Technique Best Left to Surgeon’s Preference

Cesarean section surgical technique is best left up to the surgeon’s preference, according to the latest Cochrane recommendation.

The experts from the Cochrane Pregnancy and Childbirth Group found scientific evidence increasingly shows the wide range of cesarean techniques have nearly equivalent short-term maternal outcomes.

Pertinent Points

- Surgeons should use the techniques they prefer in performing cesarean sections, because there is little evidence to support improved outcomes for any given approach.

- There are little statistical differences in surgical techniques for C-sections.

- The analysis showed few trials assessed overall clinical outcomes of the mother. Instead, the endpoints were reduction in blood loss and duration of surgery.

Some techniques, however, did show benefits to reducing blood loss, but the authors found other factors could have contributed to the associations. Ultimately, these other factors, such as duration of the surgical procedure, maternal postoperative pain, fever, wound infection, and the wellbeing of mother and infant, must also be included when evaluating the best surgical technique to use.

The review looked at 27 trials involving 17,808 women.

Using single-layer closure of the uterine incision was associated with reductions in blood loss and duration of the procedure, the review found. But of the 18 studies that showed these associations, the procedure for entering the abdominal cavity differed, which could have contributed to these reductions.

With many studies focused on reducing blood loss and the duration of the surgery, the review also noted that blunt dissection appeared to reduce blood loss and surgical time. Furthermore, the use of an auto-suture instrument did not appear to have a benefit in reducing blood loss and seemed to increase the time it took to complete the procedure.

Often, these studies focused on the endpoints of blood loss reduction and length of the surgery, with little consideration given to clinical outcomes of the women, the experts noted.

None of the trials included in the review looked at differences in outcomes for the variances in the type of uterine incisions.